Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2014 Aug 7;9(8):1354-9.
doi: 10.2215/CJN.09260913. Epub 2014 Jun 5.

Upper gastrointestinal bleeding in patients with CKD

Chih-Chia Liang  1 , Su-Ming Wang  1 , Huey-Liang Kuo  1 , Chiz-Tzung Chang  1 , Jiung-Hsiun Liu  1 , Hsin-Hung Lin  1 , I-Kuan Wang  1 , Ya-Fei Yang  1 , Yueh-Ju Lu  2 , Che-Yi Chou  3 , Chiu-Ching Huang  1
Affiliations
Observational Study

Upper gastrointestinal bleeding in patients with CKD

Chih-Chia Liang et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed.

Design, setting, participants, & measurements: Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates.

Results: In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (P<0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk.

Conclusions: In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.

Keywords: CKD; GFR; gastrointestinal complications.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cumulative incidence of upper gastrointestinal bleeding (UGIB) in patients with stages 3–5 CKD using competing-risks regression with adjustments for age, sex, diabetes, history of UGIB, H. pylori infection, hemoglobin, BUN, and albumin (UGIB was the primary outcome; competing events included death, initiation of dialysis, kidney transplant, or loss to follow-up).
See this image and copyright information in PMC

References

    1. Yang JY, Lee TC, Montez-Rath ME, Paik J, Chertow GM, Desai M, Winkelmayer WC: Trends in acute nonvariceal upper gastrointestinal bleeding in dialysis patients. J Am Soc Nephrol 23: 495–506, 2012 - PMC - PubMed
    1. Sood P, Kumar G, Nanchal R, Sakhuja A, Ahmad S, Ali M, Kumar N, Ross EA: Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol 35: 216–224, 2012 - PMC - PubMed
    1. Wasse H, Gillen DL, Ball AM, Kestenbaum BR, Seliger SL, Sherrard D, Stehman-Breen CO: Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int 64: 1455–1461, 2003 - PubMed
    1. Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P: Prognostic significance of bacterial infection in bleeding cirrhotic patients: A prospective study. Gastroenterology 108: 1828–1834, 1995 - PubMed
    1. Luo JC, Leu HB, Huang KW, Huang CC, Hou MC, Lin HC, Lee FY, Lee SD: Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis. CMAJ 183: E1345–E1351, 2011 - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources